Background Apathy is a prominent feature of geriatric depression that predicts poor clinical outcomes and hinders depression treatment. Yet little is known about the neurobiology and treatment of apathy in late-life depression. This study examined apathy prevalence in a clinical sample of depressed elderly, response of apathy to selective serotonin reuptake inhibitor (SSRI) treatment, and neuroanatomical correlates that distinguished responders from nonresponders and healthy controls. Methods Participants included 45 non-demented, elderly with major depression and 43 elderly comparison individuals. After a 2-week single-blind placebo period, depressed participants received escitalopram 10mg daily for 12 weeks. The Apathy Evaluation Scale (AES) and 24-item Hamilton Depression Rating Scale (HDRS) were administered at baseline and 12 weeks. MRI scans were acquired at baseline for concurrent structural and diffusion tensor imaging of anterior cingulate grey matter and associated white matter tracts. Results 35.5% of depressed patients suffered from apathy. This declined to 15.6% (p<0.1) following treatment, but 43% of initial sufferers continued to report significant apathy. Improvement of apathy with SSRI was independent of change in depression but correlated with larger left posterior subgenual cingulate volumes and greater fractional anisotropy of left uncinate fasciculi. Limitations modest sample size, no placebo control, post-hoc secondary analysis, use of 1.5T MRI scanner Conclusions While prevalent in geriatric depression, apathy is separable from depression with regards to medication response. Structural abnormalities of the posterior subgenual cingulate and uncinate fasciculus may perpetuate apathetic states by interfering with prefrontal cortical recruitment of limbic activity essential to motivated behavior.

Objective Colocation of mental health screening, assessment, and treatment in primary care reduces stigma, improves access, and increases coordination of care between mental health and primary care providers. However, little information exists regarding older adults’ attitudes about screening for mental health problems in primary care. The objective of this study was to evaluate older primary care patients’ acceptance of and satisfaction with screening for depression and anxiety. Methods The study was conducted at an urban, academically affiliated primary care practice serving older adults. Study patients (N = 107) were screened for depression/anxiety and underwent a post-screening survey/interview to assess their reactions to the screening experience. Results Most patients (88.6%) found the length of the screening to be “just right.” A majority found the screening questions somewhat or very acceptable (73.4%) and not at all difficult (81.9%). Most participants did not find the questions stressful (84.9%) or intrusive (91.5%); and a majority were not at all embarrassed (93.4%), upset (93.4%), or uncomfortable (88.8%) during the screening process. When asked about frequency of screening, most patients (72.4%) desired screening for depression/anxiety yearly or more. Of the 79 patients who had spoken with their physicians about mental health during the visit, 89.8% reported that it was easy or very easy to talk with their physicians about depression/anxiety. Multivariate results showed that patients with higher anxiety had a lower positive reaction to the screen when controlling for gender, age, and patient–physician communication. Conclusions These results demonstrate strong patient support for depression and anxiety screening in primary care.

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The conditions which will confront a nurse in a hospital in such a country as China are not just those in which she has received her training. Yet from many points of view they are such as to attract rather than to repel. It is the conditions that really make the work the opportunity that it is, especially in such an opening as is now pre¬ sented in the University Medical School in Canton, the foreign work of the Christian Association of the University of Pennsylvania. The work has just been started. One physician is now on the field, Ur. J. C. McCracken, 1901, University of Pennsylvania. He is purchasing land on which it is expected to erect a permanent dispensary and hos¬ pital, for which the money is in hand. At present he is at work learn¬ ing the language and meeting from twenty-five to fifty patients daily in the small temporary dispensary. The first year's work of the nurse would be that of learning the language and helping in the dispensary a few hours each day. Later on, with the coming of the hospital, her duties would be that of a graduate nurse, and as proper candidates presented themselves, she would train several assistants, acting as head nurse to them. As the hospital grows, she would train as large a staff as would be required and act as superintendent. She would need patience and ability to modify methods so as to suit existing conditions. The set rules of an American Hospital could not be imposed unchanged upon a hospital in China. But principles are the same and will in every case point to the best methods. The work is small in its begin¬ nings, and discouragements must be expected at first, but persistent effort will bring a realization of the greatness of the opportunity. There are still other attractions: chief of which, and inclusive of most, is the community of fifteen to twenty cultivated and enjoyable Americans, situated at the Canton Christian College, whose campus joins that of the Medical School. Canton also is a large city with a foreign settle¬ ment. The following quotations from a letter written by Dr. A. H. Woods while in China, and who worked in Canton for about seven years, may be of interest to any prospective candidate:

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